Treatment and ophthalmic sequelae in a horse with facial cellulitis and orbital abscess

Abstract

Summary A 22‐year‐old Quarter Horse gelding with a history of dental (107) extraction 2 weeks previously was presented with facial cellulitis and an orbital abscess. The abscess was drained surgically dorsally and ventrally to the zygomatic arch and the horse was treated with parenteral antimicrobial and anti‐inflammatory drugs. The affected eye was protected with a temporary tarsorrhaphy and treated via a subpalpebral catheter. Six months after presentation, the horse was in excellent general condition and returned to previous level of exercise but showed blindness on the affected side. Pallor of the optic disc and severe attenuation of the retinal vessels, suggestive of optic disc atrophy, were present.

Complications following oral extraction of cheek teeth: What's next?

“…The valveless nature and the wider diameter of the deeper venous sinuses of the horse's head contribute to slowing of the bloodstream and facilitated spread of septic emboli. Necropsy findings from reports by Vlaminck et al (2001) and Bach et al (2014) confirm the likelihood of vascular spread of infection that might also have been responsible for the complications encountered in the report by Racine et al (2017). As Racine et al (2017) mentioned, the iatrogenic route of infection through performance of a regional nerve block should also be considered as a possible cause of retrobulbar infection.…”

“…() confirm the likelihood of vascular spread of infection that might also have been responsible for the complications encountered in the report by Racine et al . ().…”

“…The mechanism by which infection can spread from a dental origin as hypothesised in the report by Racine et al . () is based on the induction of thrombus formation secondary to tooth extraction and retrograde seeding from the septic thrombus to more proximally located structures situated along the venous vascular system. This phenomenon of thrombus formation in venous sinuses of the head is, although rare, a well known disease process in man (i.e.…”

“…As Racine et al . () mentioned, the iatrogenic route of infection through performance of a regional nerve block should also be considered as a possible cause of retrobulbar infection. Retrograde spread of infection through the infraorbital canal following an infraorbital nerve block, or direct inoculation of bacteria in the abundance of loose connective and fatty tissue of the pterygopalatine fossa when performing a maxillary nerve block are possible.…”

“…The development of facial cellulitis and an orbital abscess following oral extraction of a cheek tooth in a horse as described in the article in this issue by Racine et al (2017) is an extremely exceptional complication. Two comparable cases have been described (Vlaminck et al 2001;Bach et al 2014).…”